Prevention of Future Deaths reports · 2022

Natasha Adams

Regulation 28 report to prevent future deaths, reference 2022-0124, written 27 Apr 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report27 Apr 2022
Reference2022-0124
DeceasedNatasha Adams
CoronerJames Bennett
Coroner areaBirmingham and Solihull
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Mental Health related deaths · Suicide (from 2015)
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

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REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO:  
Solihull Mental Health Foundation Trust 

, Chief Executive, Birmingham and 

CORONER

 I am James Bennett, Area Coroner for Birmingham and Solihull 

CORONER'S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and 
regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. 

INVESTIGATION and INQUEST 

On 23 August 2021 I commenced an investigation into the death of Natasha Mary ADAMS. The 
investigation concluded at the end of the inquest on 26 April 2022. 

CIRCUMSTANCES OF THE DEATH 

Natasha had a history of depressive symptoms and deliberate overdoses and was under the care 
of  the  mental  health  community  team.  She  was  last  reviewed  on  2  July  2021  following  an 
escalation in symptoms when it was recognised she had emotional dysregulation. She was treated 
with  medication  and  was  to  be  reviewed  again  in  October  2021.  Late  on  11  August  she  self-
presented  at  the  emergency  department  at  Queen  Elizabeth  Hospital  reporting  recent  fleeting 
suicidal thoughts of taking an overdose. She was assessed by the psychiatric liaison team to be in 
crisis but reported no immediate plan to take her own life. The liaison nurses wanted Natasha to 
attend the psychiatric decision unit for further assessment, but she had capacity to choose to go 
home,  knowing  that  she  would  be  referred  to  the  home  treatment  team.  She  was  not  in  fact 
referred until the evening of 12 August due to an administrative issue. Had she been referred, it is 
likely she would have been telephoned on the morning of 12 August when still alive. 

At  approximately  8.45pm  on  12  August  she  was  found  by  a  neighbour  at  home 

. She had left a note 

indicating her intention to end her own life. 

Following  a  post  mortem  the  medical  cause  of  death  was  determined  to  be:  1a  Suspension  by 

. 

The conclusion was death was due to suicide. 

 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 CORONER'S CONCERNS 

During  the  course  of  the  inquest  the  evidence  revealed  matters  giving  rise  to  concern.  In  my 
opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is 
my statutory duty to report to you. 

The MATTER OF CONCERN is as follows. 

BSMHFT's Root Cause Analysis Report identified that in July 2021 Natasha's level of care 
level  was  downgraded  from  CPA  to  Care  Support  without  clinicians  following  the  trust's 
Care  Management  &  CPA/Care  Support  Policy  2019.  I  heard  evidence  from  Natasha's 
family  this  had  a  dramatic  impact  on  Natasha's  mental  health.  The  RCA  action  plan 
identified  the  need  to  conduct  an  audit  of  other  patients  to  check  the  trust's  compliance 
with  the  Care  Management  &  CPA/Care  Support  Policy  2019.  The  RCA  Report  was 
released  in  December  2021.  The  evidence  was  that  4  months  later  no  action  has  been 
taken  and  other  patients  have  not  yet  had  their  cases  audited.  The  delay  is  the  trust's 
Clinical Governance Committee  needs to approve the audit process, which is unlikely to 
happen  until  the  summer  of  2022,  and  possibly  not  until  as  late  as  September  2022 
because of staff holidays. In my view until such a delay is of serious concern and action 
should be taken to bring forward the audit. 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the power to 
take such action. 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, namely by 
22 June 2022.  I, the coroner, may extend the period. 

Your  response  must  contain  details  of  action  taken  or  proposed  to  be  taken,  setting  out  the 
timetable for action. Otherwise you must explain why no action is proposed. 

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COPIES and PUBLICATION 

I  have  sent  a  copy  of  my  report  to  the  Chief  Coroner  and  to  the  following  Interested  Persons: 

, parents. 

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I am also under a duty to send the Chief Coroner a copy of your response. 

The Chief Coroner may publish either or both in a complete or redacted or summary form. He may 
send a copy of this report to any person who he believes may find it useful or of interest. You may 
make representations to me, the coroner, at the time of your response, about the release or the 
publication of your response by the Chief Coroner. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  27 April 2022 

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Signature: 

James Bennett 

Area Coroner for Birmingham and Solihull

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Birmingham and Solihull Mental Health NHS Foundation Trust (PDF)
Date: 

19 May 2022 

James Bennett 
Area Coroner for Birmingham and Solihull 
HM Coroners Court  
50 Newton Street 
Birmingham 
B4 6NE  

Legal Department 
B1 – Unit 1 
50 Summer Hill Road  
Birmingham 
B1 3RB  

Sent via e-mail only 

Dear Mr Bennett,   

RE:     PREVENTION OF FUTURE DEATHS REPORT 

Further to your Prevention of Future Deaths report in relation to the inquest for Natasha Adams 
I am writing to give you an update on progress. 

I  understand  that  the  report  was  given  due  to  the  lack  of  actions  taken  around  the 
recommendation  for  the  need  to  conduct  an  audit  of  other  patients  to  check  the  trust's 
compliance with the Care Management & CPA/Care Support Policy 2019. Firstly I am very 
sorry  that  this  action  has  not  taken  place.  As  a  Trust  we  are  taking  our  action  plans  very 
seriously and are working to improve patient care for the future, where lessons are identified 
within our Serious Incident reviews. 

With  respect  of  this  particular  recommendation;  the  delays  in  completing  our  audit  of 
compliance against our  Care  Programme  Approach  (CPA),  the national  care management 
approach in mental health, was due to capacity constraints caused by the recent Covid-19 
Omicron surge and its effect on increasing staff sickness. I can now assure you that we are 
fully  committed to  accelerate  the  completion and  reporting of  this  audit  through our  clinical 
governance  route.  The  audit  was  undertaken  by  the  Head  of  Nursing  and  Allied  Health 
Professionals on 12 May 2022. I can confirm to you that the results from the audit showed that 
80% of the patients reviewed had received a formal CPA review prior to any change.  Whilst 
20%  of  the  records  did  not  have  formal  CPA  review  completed  there  was  evidence  by  the 
Care coordinator of the approach outlined in the policy. The policy states: 

3.4.8  Where  it  is  not  possible  to  convene  a  single  meeting  of  all  involved  the  review  may 
comprise of a series of conversations and/or reports coordinated by the Care Coordinator . In 
these  cases,  the  Care  Coordinator  should  complete  the  process  by  recording  all  of  the 
decisions made in the CPA review form on RIO.  

Only 1 record did not contain evidence of a discussion taking place. The results will be reported 
through the next clinical governance group, which will take place in 24 May 2022. 

Customer Relations │ Mon – Fri, 8am – 6pm  
Tel: 0800 953 0045 │ Text: 07985 883 509      
Email: bsmhft.customerrelations@nhs.net 
Website: www.bsmhft.nhs.uk 

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 We  are  committed  to  making  the  changes  within  the  action  plan  as  well  as  continually 
identifying where further improvements can be made to ensure safe and high-quality care for 
all of our service users now and in the future. 

Yours sincerely  

Chief Executive 

Customer Relations │ Mon – Fri, 8am – 6pm  
Tel: 0800 953 0045 │ Text: 07985 883 509      
Email: bsmhft.customerrelations@nhs.net 
Website: www.bsmhft.nhs.uk

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